The Rona

I am feeling burdened these days.  We've now had several cases of COVID-19 in our region.  Since we're the only medical option up here, we're the ones dealing with what this means and what to do.  So a lot of meetings and testing contacts to try and figure out if and where "The Rona" is spreading.  We've still been pretty lucky as everyone that's tested positive has been asymptomatic or just mildly sick (like with cold symptoms), so we haven't had to hospitalize anyone.  It's a constantly moving target.

What that means for me is that I'm doing a lot of phone visits and medical coordination without seeing patients in person.  And because we still have a lot of providers that are out (either out of state or just choosing not to work), I'm pretty much running both the outpatient department and long term care.  I don't mind, though there are certain patients that really need to see their usual provider.  But tag, I'm it!  Balancing both the patient's expectations and their usual provider's expectations can be tricky.

Since I'm working long term care (LTC), I'm being tested for COVID-19 every week.  That's not the most pleasant of tests.  But we want to keep the virus out of LTC since the residents are mostly elders that don't have the best immune systems.  So we're testing all staff and residents weekly.

One of my tie dye masks, a fun activity my hospital offered

When I'm not at work, I continue to walk a lot.  Berries are starting to ripen so I've been picking blueberries and salmonberries.  I hurt my back lifting some heavy totes in June, so bending over to pick berries then sounded horrendous.  But after some PT and a TENS unit, I'm on the up and up.  It's amazing how when you have pain, it seems like it'll never resolve and it's the worst thing ever.  But then when things lighten up, you're amazed and remember that our bodies are pretty incredible at recovering.

Arctic tundra for miles, with a few wild flowers and berries in the mix. 
But curiously, not a single tree.

I went to Fairbanks for a long weekend in June.  I was supposed to meet a college friend though she couldn't make it due to COVID.  So instead, I met up with a colleague that I had never met in person (a doc that does telemedicine for several Kotzebue villages).  I stayed in her guest cabin which was set up with a bed and mosquito net.  And boy were there mosquitos.  Aggressive little suckers.

The view from my bed.  So grateful for my mosquito net.

Fairbanks was a really refreshing experience.  I didn't do the best at social distancing as I was with my colleague much of the time, and she's surrounded by people.  Really nice people.  I had some amazing home cooked meals, the best berry pie I've ever tasted and a lot of laughs.  Besides some much needed socializing, I also got to explore Fairbanks a bit including soaking in the hot springs.  I want to go back in the winter when the aurora borealis is dancing through the sky- what a sight it'll be there!

The moose antler arch in Fairbanks

I've been walking the 8.5 mile loop through the Alaskan tundra many weekends.  The tundra is mostly flat and goes forever.  There are wild flowers blooming, berries popping up and there continue to be random animal parts around.  There's a well ridden loop road, so not much danger of bears or other predators.  If you venture off the road, you're on your own.  For the most part, we stay on the road, talk about all the things and breath in the fresh air.  It's been in the 50's with a few days in the 60's- excellent for walking.  

A nurse friend took me out to expore on an ATV, such fun!

It's still light 24 hours a day here though the sun will dip more and more in the coming weeks.  Then it will be "normal" for a little while with both day and night, then the darkness will set in for winter.  When I was interviewing for this job, I was told the light is a bigger problem than the darkness.  I guess it depends on what problem we're speaking of.  But for sleep, the infinite light definitely plays a role.  There's no cue that it's time for bed.  Many set an alarm.  Or just stay up much of the night, go to bed when the sun starts to dip (around 2-3am), then sleep until afternoon.  Since I'm due at work at 8am, I have to get myself into my bedroom with my blinds and dark curtains to get my brain producing some melatonin to aid in sleep.  Doesn't always work well and 8am often comes too soon.  But I try.

I'm an honorary Native Alaskan now

4th of July was fun.  We had a parade with every fire engine, police car and ambulance we have out here.  Also the coast guard helicopter took a pass and there were a few floats.  It was better than halloween for the kids, candy was thrown into the spectators from every vehicle.  There were no bands or singers, not sure if that was because of COVID or because we just don't do that here.  Everyone kept their distance on the sidewalks, some had masks and it all felt very festive.  Because of the no darkness here, there were no official fireworks.  Though I heard a few that evening.

One of the floats, "Catch fish, not COVID"

We'll see what these next weeks and months bring.  Feels a bit like Groundhog's Day, like we're just playing out the same day over and over.  Maybe because of The Rona.  Maybe because it's Kotzebue.  But I try to find little things to mix things up, break up the monotany.  Hearing from friends and family is the best, please reach out or use snail mail :)

Self Isolation

What a drag this COVID-19 is.
We've been lucky enough not to have a case (yet) here in Kotzebue.  Since the only way in is by plane, we have public health nurses stationed at the airport offering COVID-19 screening right then and there.  Only 70-80% of passengers take advantage of this, though all are advised to self-quarantine x 14 days once they reach their final destination (Kotzebue or one of the villages).

One of many handmade masks that have been donated

There's been a lot of fear up here.  Though we have no cases, there are a lot of questions.  The Spanish Flu in 1918 hit hard up here, wiping out large numbers of people in the Arctic.  This has been on people's minds, lots of worry and fear.  Therefore, we're seeing a lot fewer patients both in the village clinics and at the hospital in Kotzebue.  Even when we recommend they come in, some have refused, choosing to suffer it out.  That's been hard for us, trying to properly care for our patients that won't show up.  Of course we're delaying elective visits and procedures.  But we still need to check in and address the acute issues that come along.
There's also a lot of uncertainty for our medical staff.  We are just a small community hospital without an ICU.  We do have a couple ventilators that we've dusted off, though few of us are fully comfortable using them if/when needed.  When COVID-19 first hit the US in mid-March, we jumped into high gear and came up with trainings and protocols.  We transformed rooms, preparing for pandemic numbers to flood through our doors.  Those plans are still in place, though we've become much more relaxed.  That doesn't mean we don't expect the virus to come, because we absolutely do.  But we have so few cases in Alaska that now, if we get a really sick patient, there's more of a chance we can fly them down to Anchorage safely so they can get all the care they need.

One of our planes that go to the villages

I've been enjoying the outdoors whenever I can.  It's now light from 5am - 1am, so there's plenty of opportunity to be out, even after work.  My neighbors were kind enough to come over and put up some blinds on my bedroom window so I can block out the sun to sleep.  I'm still not shutting down very efficiently and often find myself wide awake well after 10pm, making 6am seem awefully early to have to get up.

Warmer and longer days

The lagoon outside my window still has a solid ice cover, though the overlying snow is mostly melted.  And the snow piled up all over the sides of the roads is now producing impressive puddles that are challenging to traverse.  I've had to find a new route to work to avoid getting my feet soaked on the way.  And some days, the puddles in town have been so deep that vehicles have to redirect for fear of ruining their engines by submersion.

These puddles are intense

We have an 8.5 mile loop outside of town that I've been enjoying.  My neighbors are very ambitious and have been taking me along for the hike.  

It's so pretty here

We've heard rumors of a moose sighting though have yet to spot it ourself.  But there are tons of birds that have seemingly appeared out of no-where.  Even ducks, suddenly here and bustling about.  We have big black crows that hang around through the winter, they are tough.

The crows are resilient

Some caribous parts discovered on a loop hike

We should be getting berries soon, that will be fun.  Bears also enjoy the berries, so I'll stick with my neighbors who have both bear spray and a gun.
One wonderful thing my hospital has started offering is fruit and veggie boxes.  There are 4 different options that can be ordered once a week and are delivered right to the hospital.  I got my first box a couple weeks ago and get my next one this week.  What a treat to have lettuce, snap peas, fingerling potatoes- I could go on and on.  Having something to prepare that's not frozen or canned is fabulous!

Fresh fruits and veggies- so yum!

I'm anxious to be able to take another trip to civilization, even within Alaska.  I don't want to have to self-quarantine x 14 days when I come back, so am holding off for now.  But there's something about being able to grocery shop and eat food prepared by someone else that is so intruiging.

A new shelf I procured to use as a pantry.  I still have a decent sized stash.

Until then, I will continue exploring this northern land and soak up all the Vitamin D that the extended sunlight has to offer.

Spring and COVID

Hello again.
Things have certainly changed since I last wrote.  This new and novel coronavirus has been throwing us all for a loop.  I left for a medical conference on March 10th and the very next day, my hospital mandated all permanent employees stay in the region.  Since I was already gone, I attended my conference in Colorado Springs.

My roomies and I for the conference

The conference was still really good (I love AAO Convocation) though many of the atendees had to cancel and we were trying to follow makeshift regulations during the program.  Because no more than 250 people were supposed to gather in one space, the conference center had to be opened up further and all of our chairs were placed 6 feet apart.  The regulations got stricter as the days passed and by the end of the week, there were concerns for travel restrictions to fly home.  I was planning to stay in Colorado to go skiing with my brother and sister-in-law but the resorts all closed.  So my choices were to fly back to Alaska early or go somewhere else.  I needed a break from Kotzebue so decided to fly to Washington DC to be with my brother for a few days.  It was a wonderful break despite having limited options and trying to adhere to social distancing.  The best part was the DC cherry blossoms were in full bloom, so we were able to walk outside and enjoy the beauty.

My nephew Dudley

Beautiful DC cherry blossoms

I returned to Kotzebue on 3/20/20.  I thought I would be mandated to quarantine at home x 14 days.  However, initially, my work let me back into the hospital with the caveat that I wear a mask and get my temperature checked twice daily x 14 days.  But as of today, I'm self-quarantining while working at home for the remainder of my 14 days.  So far, I'm feeling fine.

Following the rules with my mask on while at work

Thankfully, I live in the perfect place for this quarantine as I have plenty of food and supplies.  We have always stockpiled since there aren't affordable stores here- brilliant.  For now, social gatherings have been cancelled, including hanging out in the hospital lobby or cafeteria, which was the norm for many townspeople.  We now have people at the hospital entrance screening patients.  And if they don't meet criteria or don't have an appointment, they're sent away.  Patient appointments have been either converted to tele-visits or post-poned unless they are approved to be seen in person.  We've always done tele-visits for village patients, so it hasn't been too difficult to incorporate this for our local patients as well.  Of course, there are limitations when we don't get to see people in person or check their vital signs (temperature, blood pressure, etc).  But we do our best.
A permanent provider left at the end of February, so I have taken over her panel of patients.  What that means is I have been reassigned from my original village of Point Hope to Noatak.  I was supposed to go to Point Hope next week for the last time but that has been cancelled due to COVID.  So now I need to move on and figure out this new village of mine.  I've heard it's beautiful there, inland and right along a river.  With trees, oh how I've missed having trees!

Portrait taken for a mailing being sent to my new village, Noatak

The days are getting longer here in Kotzebue.  We currently have more than 12 hours of sunlight, and that will only increase.  It's just now starting to get light when I walk to work just before 8am.  But it's still light until after 9pm.  Pretty soon, I'll need to close the shades in my bedroom so I 'm not kept up all night.

Giant icicles- a result of warmer days

It's also started being warmer this month.  The winter was much colder than recent years, consistently in the negative degrees Fahrenheit.  However, it's been in the positives the last couple weeks.  Because of this, it's snowing more.  In the 2 weeks I was gone, it snowed several feet and the piles of snow on the sides of the road are impressive.

Snow piling 1/2 way up my windows, partially blocking my view of the beautiful lagoon

Walking to work is a bit more challenging with all this snow.  There's often several new inches overnight, so walking requires more effort to move my boots along.  However, I got some cross country skis in January and that's been great.  Unfortunately, I slipped on some ice while cross country skiing earlier this month and hurt my wrist.  It's a lot better now but has made me wary of skiing on the roads which tend to be more slick.  Instead, I prefer to ski on the water (lagoon, sound) where the snow is less compact and there's less to slip on.

My neighbor and I, heading out on a ski

A random caribou hoof we encountered on one of our walks

It's been fun to watch dog sled teams out on the lagoon.  The Ididerod (big dog sled race from Anchorage to Nome) was at the beginning of the month and it was all over the news.  The Kobuk 440 is a smaller race that starts and ends in Kotzebue.  It was supposed to happen in April though it's been officially cancelled due to COVID (http://www.thearcticsounder.com/article/2012kobuk_440_cancelled_in_light_of_covid-19).  So unfortunately I won't get to experience the excitement of the actual race, but I get a front row seat to watch some teams that are out for a run and it's fabulous.

A small dog team pulling both a sled and their cross country skiing leader- he took a big spill soon after this pic!

So, stay well!  I do hope this virus gets defeated soon though it's hard to know when.  I want to be able to get out when I need to, and the only way for that to happen is for COVID to take a hike.

Holidays

I made it through the holidays in this cold, dark place.  The Arctic is like a whole other world.  Though I still go to work, the darkness seems to slow everything down.  We hardly see any patients before noon.  Then the sun starts peeking over the horizon, it's like people just aren't willing/ready to start the day without some light.  I wonder how it will be during the summer when the sun never leaves- maybe terrible insomnia??

A little Christmas cheer at the Arctic Heritage Center

I've been continuing to enjoy exploring this region by foot.  My neighbors and I have been going out on long treks every weekend, more with our days off during the holidays.  Depending on the day, it can be clear and gorgeous or so windy you can hardly put one foot in front of the other.  Though it's cold, it hasn't snowed much this season.  However, snow is still several feet deep and when you're off of a trail, you often find yourself sinking or dropping through the upper crust, sometimes thigh deep.  That can make for a difficult journey.

View of Kotzebue from across the lagoon on a Christmas Eve hike

We've taken to walking on top of bodies of water.  I really like walking across the lagoon that's just outside my window.  Sometimes you'll hear a crack when walking, a bit nerve wracking but we've been assured the ice is 2+ feet thick, so the cracking is really just settling of the layers, not the ice giving way.
We also walk on the sound, which is salt water.  Because of the current, the ice there is thinner.  And there are deep cracks/crevices, especially close to shore.  However, the ice is still a couple feet thick and feels very sturdy to walk on.  There is a lot of travel by snow machine across this ice to get to surrounding villages.  They mark the direction with sticks that go for miles.  I saw a couple of SUVs out on the sound the other day- that made me nervous.  But they must trust that the ice will hold.

One of the many large cracks in the ice.  We still walked on it and it felt solid and sturdy.

We spoke with some ice fishermen the other day.  They had drilled small holes through the ice and were using strings on a short stick with hooks and bate.  The one guy was pulling up a new fish every 30 seconds, it was amazing.  The fish are called sheefish and they're relatively small.  The natives eat them whole, just fry then up and eat.  With the temperature being so cold, I can't imagine being outside and sedentary, fishing over an uncovered hole for hours at a time.  But that's what people do.
Speaking of cold, it's gotten down to -35F (-37C)- now that's cold.  With the wind chill, it was in the -50's.  I've been bundling, not with more layers, but making sure every part of me is covered and protected.  I remember when I hiked Mt. Kilimanjaro and the temperature dropped low at night.  Our guide told us the smartest thing to do is wear minimal clothing inside our sleeping bag but sleep with hot water bottles, that way you heat the bag up and it forms a cacoon of warmth around you.  Too many layers actually made things worse.  So I'm working on believing and living that principle here in the Arctic.

My neighbors are hard core and go out in any weather.  I've been declining to join them when it's below -15.  I still go to and from the hospital for work.  But that's enough on the cold cold days.
My saga with the mail system also continues.  I had a FedEx package "delivered" according to the website, only it was no-where to be found.  When I finally got a human on the phone, I discovered that they only deliver on Mondays but mark packages "delivered" when they arrive at the airport.  However, Monday came and went and still no package.  Then on Tuesday, a man from the airport called saying I had a package waiting for me.  I asked if it could be delivered, he said they don't really do that (???) but then said he could drop it by the hospital.  Remember, everything here is within a 5 minute drive of the airport.  So I waited and waited, no package.  Then the next day, 2 men showed up at my clinic with my package.  It was quite something, however hit or miss the system is.
I went back to my village, Point Hope.  Once again, flights were affected by wind.  I was supposed to go Monday but both flights out were cancelled due to blizzard warnings so I stayed put until Tuesday.  Then on Thursday, flights were cancelled due to high winds so I stayed a bonus night and got out Friday.

My accomodations at the Point Hope clinic, a bed in the women's health exam room.

Clinic in Point Hope is so different than anywhere else.  I brought a list of patients that I wanted to see while I was there- mostly patients with chronic conditions that need to be monitored like diabetes or heart disease.  Only 4 of those patients were scheduled and just 3 of them actually came in to be seen.  However, I did see a lot of the mundane stuff like colds, rashes, joint sprains- the things the CHAPs (community health aids) are able to handle.  It would be nice to figure out how to get the patients that need to see a doctor to come in.

Dramatic colors with the sunrise in Point Hope

There is a small pharmacy in the village clinics.  There are over-the-counter medications (tylenol, mylanta, antibiotic ointment) as well as a handful of prescription medications in something called a pick point.  I order them through our electronic health record, the order goes to the pharmacist in Kotzebue to verify, then they release the medication to the pick point.  That's like a big vending machine that finds the medication requested and dispenses it.  Then I attach a label and hand it to the patient.  If a patient needs something not available in the village or a maintenance medication, that needs to be sent on the next plane (ideally the next day, limited by wind in Point Hope).
Same with the laboratory.  We collect blood, urine, swabs from wounds, etc in the clinic.  Then we have to print out labels, package and store them until the next flight comes so we can send the labs to Kotzebue to be processed.  Sometimes in Point Hope, you collect a sample and have to wait days just to get it sent to the lab, then wait another while for the result.  So not a super efficient system, but better than having to send the patient every time they needed labs done.  I'm quite enjoying drawing blood, something I haven't done since residency (and even then, we barely did it since our phlebotomists/nurses were on it).
I got to go to Anchorage for a long weekend.  AND my mom joined me, then came up to Kotzebue for a week.  We spent most of our time in Anchorage buying food and supplies to take back with me.  I even got cross country skiis and look forward to trying them out.  We went to the movies, ate delicious food and saw 2 moose just wandering around.  My mom was trying to get used to the cold (it was around zero on day one though warmed up to a balmy 20 degrees) in preparation for the even colder arctic.

Enjoyed this large polar bear

Anchorage was beautiful.  And so many trees!

My mom's visit was wonderful.  I don't get terribly lonely though there are moments where I just want something or someone familiar.  Phone calls are great, letters/packages are fabulous but an in-person visit, wow!  I don't expect many visitors since this is a pretty isolated place, but anyone who's curious about the arctic is welcome any time!

Shenanigans

I'm chugging along up here. One year older.

Since my last post, I've experienced a couple of winter storms.  The first was 2 days before Thanksgiving and shut down the clinic due to high winds and blowing snow.  Though I lost power often, it came back quickly each time, meaning I was warm and happy in my apartment, watching the snow whip by.  The second storm was less severe, I chose to stay in doors though my neighbors ventured out on a walk to check it out.  The pattern seems to be it gets really cold (like below zero) for a couple of days, then it warms up and storms. 

The wind was intense!

The sub-zero temperatures are intense.  It's interesting how I now feel a distinct difference between 32° F (0° C) and 0° F (-18° C).  I have come up with an appropriate outfit for the really cold days and I'm managing to stay warm.  I'll probably start wearing snow pants on wetter days, though currently, I choose to allow my knees to be vulnerable to the cold to save a few minutes of dressing.  The other day the temperature was in the low 30's and I was sweating (for real) in my winter ensemble.  So I leave the scarf and hat off on those days now.

My winter getup, about to leave work.

My face shield blew away the other day.  I had too many things in my hands as I was walking home from work.  I didn't realize a bag was missing until I got to my apartment, so I went on a quest to find it.  I managed to recover my work ID badge, scarf, hat and a fork (from my lunch).  But the bag, lunch tupperware and face shield are no more.  Blown away.  Keep in mind it's dark most of the time now, so there isn't much opportunity to search in daylight.  Currently, the sun rises ~12:30pm and sets before 3pm.  No bright sun.

An incredible care package received in record time!

I've learned a bit more about the mail system here.  There is USPS (the post office), then there is UPS and other private shipping companies.  Both are iffy.  The biggest issue with the post office in Kotzebue is staffing.  When people are on leave or sick, the place literally shuts down.  It was closed for a full week before Thanksgiving, then opened with limited hours for another week.  What that means is you don't get your mail.  Even if something was sent weeks before, it sits until someone sorts the mail, which no-one was doing for a while.  They also put a hold on all packages for a while, so everything was piling up in Anchorage somewhere.  I didn't know a post office could do that.  It's a government agency, one might think they would provide relief staff in these circumstances.  But no.

The private shipping companies receive mail through a different airline carrier.  Though the packages get shipped up here, they don't necessarily get delivered in a timely manner.  The local delivery people drive a white, unmarked van.  They often show up on a Saturday.  But not every Saturday.  I've heard you can go directly to the airport to get your packages.  But you have to know they're there, and tracking ends once a shipment reaches Anchorage.  So how's a girl to know??

Then there are the packages that are sent to my street address but end up at the post office.  I have a PO Box there.  Though if the PO Box number isn't written on the package, the package sits in the orphan bin.  One might think they would make an effort to match your name with your PO Box, but no.  Instead, they will announce a list of names of people that have this variety of package on the radio and Facebook.  But they won't reach out directly to the person, too much effort.  Sometimes I wonder...

I also found out today that we're on a cargo hold.  That mostly affects large shipments, so things like food for restaurants, furniture orders and vehicles.  I guess Kotzebue is out of eggs and will be for at least 3 more days.  I personally have eggs that I hand carried on the plane from Anchorage.  But you can't buy them at the store or order them at a restaurant (including the hospital).  Kinda crazy.  And so much worse for the villages.

Who would think Kotzebue would ever be given that title??

Speaking of villages, I'll be back in Point Hope in early January for a week.  Please cross your fingers and toes that the weather is good while I'm there- I don't want to get stuck again.  The wind is worse in Point Hope since it's right on the coast and the open sea.  It's a bit warmer than Kotzebue (still below freezing) but the wind chill is intense.  And it's often not safe to fly with the wind.  I keep trying to remind myself that I'm going there to help the people and they deserve that.  But I also really want to be back in my own bed as scheduled.  There's no way to know until it happens, so we'll see.

Typical view from my apartment window these days

Otherwise, I've just been working and enjoying the view from my apartment.  These days, there are a lot of snow machines that whiz across the ice.  Also dog sled teams, they are fun to watch.  Those dogs are so resilient.  They live outside and are all business.  Video is from October (before the snow) of some dog sled training.

I've been a on few walks on the weekend.  I haven't see the foxes but I guess there are a couple up the hill, I've seen their tracks in the snow.  And one moose, I've seen her droppings.  No recent bear sightings (probably hybernating??) though my neighbor is procuring a gun to carry with us when we hike just in case.  We're planning a longer walk out to the tip of Kotzebue, it'll take all day and you don't want to get caught unaware!

Merry Christmas and Happy New Year!

Connection

I've been thinking a lot about feeling and being connected lately.  Selfishly, but also for the people that live in Kotzebue full-time.
One of the first things I wanted figured out when I arrived here was a WiFi connection.  My mobile carrier is Verizon, and there's no service.  AT&T has a tower, but alas, that's not my company.  So my phone roams all day long, sucking data and still not having a reliable or consistent connection.  At the hospital, there is WiFi and I can use WiFi calling though Verizon.  Works pretty well, I'm able to call and receive calls.  But as soon as I leave work, I'm back in the same boat.
So I researched WiFi options for my apartment.  There seem to be 2 options in town, one is through a cable company, the other is through satellite.  For unlimited data, satellite is the way to go.  BUT, the signal is hit or miss and could be out for weeks.  So cable is what most people use.  The problem with cable is it's a data plan system, so you choose how many GB you want and what speed.  The fastest speed option is up to 10 Mbps.  From what I've been told by tech savvy people, 10 Mbps is still pretty slow.  And the "up to" part is key, as it's often slower than that.

I went to sign up for cable internet only to find out they were out of WiFi routers through Jan 2020.  I could get hooked up through a modem, but I would only have a hard connection through an ethernet cable, no WiFi.  That wouldn't work for me.  So I asked my neighbors if we could share WiFi.  They agreed, and everything was great for a weekend.  But before we knew it, they were out of data and asked me to stop using their WiFi.  Luckily, one of the nurses had an extra router, I got my own cable hooked up, and voila, I now have WiFi.  I have to monitor my usage to make sure I don't run out of data.  And when it's slow, it's slow.  That's just the way it is.
Though I enjoy streaming shows and movies, my real motivation for having WiFi is to be able to call family and friends.  Though I could stay at the hospital and chat, being at home on my couch gives me a better feeling.  More relaxed, less rushed.  Unfortunately, there's often an echo or voices cut out.  But not always.  So I'll keep calling, keep texting.  Hope I don't get cut off.
Then there are the native people here.  They are called Inupiat.  Culturally, they are a subsistence tribe, meaning they live off the land.  Many natives still enjoy hunting and fishing, making clothing out of the skins from their hunt and building with their hands.  That doesn't mean they don't enjoy the luxuries of modern life.  Most people I've met have a cell phone, drive vehicles and live in proper structures.  But they also have camps out of town where they go, off the beaten path and away from modern conveniences.  Maybe I'll be invited to go to a camp one day, I'd like that.

A dog sled out for a run over the frozen lagoon. 
If you look close, you can see modern windmills beyond the hill in the distance.

Everyone speaks English though they also have their native language, Inupiaq.  Like with other native people groups, their culture and language were threatened and discouraged after the Europeans came.  Thankfully, thoughts have shifted and there are more efforts to preserve and celebrate their culture now.  For example, our hospital has a long term care wing for the elderly, and they serve local cuisine (caribou, muktuk= whale blubber, seal oil, etc) once a month for their residents to enjoy.  My patients often use Inupiaq words mixed into their English sentences.  They'll say "I have a lot of nuvak", which means mucus/phlegm.  I'm trying to catch on.

Muktuk- whale skin and blubber.  Usually eaten raw, though can also be eaten frozen or cooked.

I was able to take a weekend trip to Anchorage over Veteran's Day weekend.  Along with some shopping to replenish my food pantry, I made an appointment with a dentist (thankfully they were open on Veteran's Day) and checked out the city.  It was refreshing to get away, see the beautiful mountains, check out the zoo and museum.  Go see a movie.  Overall, it was an enjoyable trip.

The amazing mountains behind the fun eat-in theater I enjoyed in Anchorage

As soon as I got back, I repacked and headed to my first village- Point Hope.  To read a bit about the village: https://en.wikipedia.org/wiki/Point_Hope,_Alaska.

The flight took 1 hour on a single propellar plane.  I got to the airport 1.5 hours early, had to wait outside in the cold for 45 minutes until the terminal opened, then waited another 30 minutes before they finally took my bags and we walked right onto the plane.  No ID needed.  Full water bottle, no problem.  I went with a PA student (Ciara) and we were the only 2 passengers along with 2 pilots (we think one might have been learning), 3 empty seats and the rest of the plane full of cargo.  Like large boxes of tortilla chips.  Ciara and I figured if we crashed, we'd at least have chips to keep eat :)
We arrived at 10 am, the sun was just starting to come up over the horizon.  From above, Point Hope looks like a perfect rectangular grid.  The airport was the tarmak and a few vehicles waiting to pick up the cargo and passengers.  No building.  When we got off the plane, we collected our luggage from the lower compartment of the plane and looked for our ride.  We couldn't find anyone from the clinic, so hopped on the senior center van which took us right to our clinic.

Point Hope from the plane just before landing at 10am.

The clinic is actually quite roomy.  There are 4 medical exam rooms, 1 dental room, a couple counseling rooms, a trauma bay and a couple of sleep rooms.  The dentist and one of the counselors live in Point Hope year round (unusual for most villages).  Currently, there are 2 CHAPs (Community Health Aids) who manage the patients 24-7 when no providers are present.  They call in to the "Radio Room" in Kotzebue that's manned by a provider who advises on any medical interventions or treatments that might be necessary.  The CHAPs handle it all- anything from the common cold to major trauma, overdoses, deliveries.  Of course, anything too complex gets sent to Kotz or Anchorage via medivac.  

The clinic with our trusty ATV parked in front

The clinic was short staffed, so Ciara and I had to do our own thing during our stay.  We roomed the patients, got our own vitals, drew blood, gave vaccines.  Nothing too ground breaking, but things I haven't done in years (or ever).  There is a small pharmacy in the clinic that has basic medications in a kind of vending machine.  If I needed a med, I'd order it and the computer would tell me if it was available in the village or if it would have to be sent out from Kotzebue.  If there was a flight delay, we'd try and scramble to find a temporary supply for the patient to help manage their symptoms until the plane could land.  And if labs were collected, we also relied on planes to transport them to the lab in Kotz.  Lots of delays with this system.
It was very windy while we were there, gusts 60+ mph.  The temperatures were in the teens, but with the wind chill, it got into the negative teens- burrrrrr.  We rode an ATV around the town, but our faces and fingers got so frozen we couldn't stay out long.  Then it took a while to get our fingers feeling back to normal.  Frost bite was a fear, thankfully we didn't push the limit that far.  Though we also couldn't resist getting out and about a bit.
Point Hope is known for whaling.  The season starts in April/May and there's a big celebration in June every year- 100+ people fly in, making PH a hopping place.  There are whale bones stacked up around the town, some artistically placed.  They also use whale bones to mark their cemetary- I got to see it but didn't get a picture as we were in a rush to catch a plane.  When a whale is caught, they cut it up and distribute the pieces among the towns people.  We were told they bury the tail and wait for it to ferment.  Sign of fermentation is when the water slushes, then they dig up the tail and again, distribute to those who want it.  One of my patients said only the elders eat the tail these days.

Some artsy whale bones out in the tundra.  It was hard to take my glove off long enough to snap this pic with the wind chill!

We were supposed to leave Thursday afternoon.  But with the high winds, all flights were cancelled.  The wind continued to howl through the night, and the morning flights were also cancelled.  Luckily, the winds calmed down enough to allow a flight to come get us Friday evening.  Otherwise, who knows.  I had heard there could be weather delays.  I didn't know it would happen on my first trip up.  But I now know PH is a windy place through the winter and not to expect to arrive or depart as scheduled.  I'm scheduled to go back in January, we'll see.

One of the planes.  This one left Friday afternoon without us- it was a charter flight and they were full!

It was interesting how much different PH felt from Kotz.  Yes, it was smaller.  People were mostly nice.  But everything was slower.  The computers, the pace of the clinic.  I didn't mind being there but I found myself longing for my apartment in Kotzebue.  I wanted my bed, my TV, my WiFi.  That extra day was rough.  I got to help out the CHAPs with a midnight overdose I would have otherwise missed.  I tried the local pizza (surprisingly quite good).  And when I got back to Kotz, I was finally able to rest.
There will be more new experiences with the holidays coming up. Opportunities to get to know my collegues and neighbors better.  Explore the town, especially when I'm properly dressed and there's some daylight.  I'm trying to take one day at a time.  Not get too bogged down with the little details (hard for me).  I'm taking vitamin D.  I still really enjoy my sun-rise alarm clock.  Let's see what more Kotz has in store.

Waiting for a plane to taxi with my neighbor on one of our weekend walks.